Browsing by Author "Kuruvilla, A"

Now showing 1 - 20 of 34
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    Accessory deep peroneal nerve
    (NEUROLOGY INDIA, 2004)
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    Acquired syphilitic retinitis and HIV
    (LANCET, 2000) Kuruvilla, A
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    Acute endovascular recanalization therapy in wake-up stroke
    (JOURNAL OF THE NEUROLOGICAL SCIENCES, 2011) Kuruvilla, A; Norris, GM; Xavier, AR
    Background and Purpose: Up to 15-25% of patients with ischemic stroke wake up with their deficits. Because of the uncertainty about the time of onset, these patients are generally not offered thrombolytic therapy. Some of these wake-up stroke patients may be eligible for acute endovascular stroke therapy based on hyperacute CT or MR imaging independent of the time window. Report: We report two patients with acute ischemic stroke whose symptoms were present upon awakening and who were successfully treated with endovascular interventions. Results: The first patient was discharged with complete neurological recovery on second day after endovascular intervention. The second patient went home on fifth day with a mild left facial paresis and left arm drift. Both these patients did not he any neurological deficit on 18-month follow up. Conclusions: Some patients who present with stroke on awakening may be candidates for thrombolytic therapy or recanalization techniques irrespective of mode of therapy (intravenous, intravenous + intraarterial or intra-arterial tPA alone). Further randomized, controlled studies are warranted to safely identify those candidates who would benefit from thrombolysis and endovascular interventions in ischemic wake-up strokes. (C) 2010 Elsevier B.V. All rights reserved.
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    An expert system for the diagnosis of epilepsy: Results of a clinical trial
    (NATIONAL MEDICAL JOURNAL OF INDIA, 2001)
    Background. Artificial intelligence is an area where computer systems are used to solve real-life problems that require expert human intelligence. Expert systems serve as an effective alternative to supplement the dearth of human experts in a narrow domain of applications. We developed an expert system named SEIZ using DIAGNOS (an expert system shell for diagnostic applications) for the diagnosis and management of epilepsy.Methods. A clinical trial was done to test the reliability of SEIZ. The clinical and demographic data from the medical records of 50 patients with epilepsy who attended an epilepsy clinic were provided to the expert system. The system-generated diagnosis was compared with the clinical diagnosis.Results. The seizure types and epileptic syndromes for the 50 patients included generalized tonic-clonic seizure (14), absence (4), complex partial seizure (18), simple partial seizure (4), juvenile myoclonic epilepsy (5) and other epileptic syndromes (3). There were two cases of hysterical conversion reaction. There was concordance in the diagnosis between the expert system and clinician in 47 cases (94%). The overall sensitivity was 94% and the specificity was 100% for absence, generalized tonic-clonic seizures, simple partial seizures and juvenile myoclonic epilepsy; 94 for for complex partial seizures and 98% for hysterical conversion reaction.Conclusions This expert system could generate reliable diagnoses for patients with epilepsy. Such a system may be useful for a doctor In a remote or peripheral area where an expert on epilepsy is not available.
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    Anomalous superficial radial nerve: A patient with probable autosomal dominant inheritance of the anomaly
    (MUSCLE & NERVE, 2002) Kuruvilla, A; Laaksonen, S; Falck, B
    The sensory symptoms due to lesions of the superficial branch of the radial nerve are usually limited to the dorsolateral area of the hand. We describe a 40-year-old woman who presented with numbness of the dorsomedial aspect of the right hand following arthroplasty of the wrist. Clinically, the sensory loss suggested a lesion of the dorsal branch of the ulnar nerve. However, nerve conduction studies showed that the sensory loss was due to a lesion of a branch of the superficial branch of the radial nerve. The patient had bilateral, anomalous innervation of the dorsum of the hand-the dorsal branch of the ulnar nerve could not be demonstrated with nerve conduction techniques and the superficial branch of the radial nerve innervated most of the dorsum of the hand. Antidromic stimulation of the dorsal branch of the ulnar nerve and superficial branch of the radial nerve with paired surface recording of sensory nerve action potentials from the dorsolateral (radial side) and dorsomedial (ulnar side) hand is useful for evaluating this anomaly. Our patient had two children, one of them with a similar anomaly. This suggests an autosomal dominant inheritance of the anomaly. (C) 2002 Wiley Periodicals, Inc.
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    Beta band seizure pattern : Neuroimage
    (NEUROLOGY INDIA, 2001)
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    Brainstem auditory evoked potentials in newborns with hyperbilirubinemia
    (JOURNAL OF THE NEUROLOGICAL SCIENCES, 2005) Kuruvilla, A; Sankar, VH
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    Clinical, electrophysiologic, and histopathologic profile, and outcome in idiopathic inflammatory myositis: An analysis of 68 cases
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2010) Ramesha, KN; Kuruvilla, A; Sarma, PS; Radhakrishnan, VV
    Objectives: To study the electroclinical and histopathologic profile of idiopathic inflammatory myositis (IIM) with reference to prognosis and survival rate. Materials and Methods: Diagnosis of IIM was based on the Bohan and Peter criteria. Patients who improved and those whose condition worsened or who expired due to IIM per se at last follow-up were classified to have favorable and poor outcomes, respectively. Fishers exact test was used for univariate analysis of prognostic factors. Results: The study cohort consisted of consecutive 68 patients with IIM. The mean age at diagnosis was 36.5 years and females constituted 71%. Of these patients, 62% had definite IIM, 49% had polymyositis, 20% had dermatomyositis, and 29% had overlap syndrome. The mean follow-up period was 5.4 years. Prednisolone alone was used in 55 (80%), and azathioprine (1-3 mg/kg/day) alone in 12 (17.6%) as the initial treatment. Relapse of IIM with drug withdrawal was seen in 15 patients (22%); 70% had favorable outcome and 16% had expired. The treatment delay of %6 months (P = 0.001), absence of cardiac or lung involvement (P < 0.001), and positive biopsy (P = 0.033) were predictive of a favorable prognosis in the univariate analysis. In multivariate analysis, only the duration of illness of %6 months (P = 0.008) and the absence of cardiac or lung involvement (P = 0.001) predicted the favorable outcome at last follow-up. Cumulative survival rate was 95% at 1 year, 86% at the 5th year, and 80% at the 10th year. Conclusions: Approximately, two-thirds of the patients showed good electroclinical and histopathologic correlations and an equal number improved with treatment. The treatment delay (>= 6 months), presence of cardiac or pulmonary involvements, and negative muscle biopsy are bad prognostic factors.
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    COMBINED CLOT BURDEN SCORE AND COLLATERAL SCORE PREDICT OUTCOME IN ACUTE MIDDLE CEREBRAL ARTERY STROKE
    (INTERNATIONAL JOURNAL OF STROKE, 2016) Maniangatt, S; Jayadevan, E; Satyanarayana, M; Sreedharan, SE; Kuruvilla, A; Sajith, S; Sylaja, P
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    Cryptococcal meningitis and Cushing's syndrome
    (LANCET, 2000) Kuruvilla, A
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    'Face of the giant panda' sign in Wilson's disease: Revisited
    (NEUROLOGY INDIA, 2000)
    We report a patient, with Wilson's disease, who showed the characteristic radiological sign known as 'Face of the giant panda sign' on magnetic resonance imaging (MRI) of the brain.
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    Fast-wave periodic complexes in a mentally retarded child who later developed subacute sclerosing panencephalitis: a modification of a classic EEG by preexisting brain damage?
    (DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY, 1997) Narayan, SK; Kuruvilla, A; Shanmugam, J; Radhakrishnan, VV
    The EEG of a 12-year-old girl with stage II subacute sclerosing panencephalitis (SSPE), who had also suffered from a non-progressive mental retardation of unknown aetiology since early childhood, revealed periodic generalised stereotyped fast wave bursts synchronous with myoclonic jerks, The background activity was nearly normal, The diagnosis of SSPE was established by raised serum and measles antibody titres, raised CSF IgG, and brain biopsy, This rare type of periodic complex has only once been described in the literature, again in a mentally retarded child who had developed SSPE, We suggest a mechanism of origin of this type of periodic complex drawn from observations in these two cases, anti discuss its significance.
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    Femoral neuropathy following cardiac catheterization for balloon mitral valvotomy
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 1999) Kuruvilla, A; Kuruttukulam, G; Francis, B
    Femoral neuropathy is a very rare complication of cardiac catheterization. We report an adult female who developed femoral neuropathy after undergoing cardiac catheterization through femoral vein for balloon mitral valvotomy. Neuropathy was confirmed by electromyography and nerve conduction studies and the patient showed spontaneous recovery over a course of 6 months. Use of prolonged digital pressure for post-procedural hemostasis is implicated as possible etiology. Such complications can be prevented by by minimising the procedural time, avoiding injury to the vessels and maintaining optimal posture of patient's thigh by limiting abduction and external rotation of hip. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.
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    Inflammatory myopathies--a clinicopathologic study.
    (Indian journal of pathology & microbiology, 1997)
    In this study, clinical, histopathological and immunological profiles were analysed in ten patients with inflammatory myopathies. Polymyositis and dermatomyositis were more common than other forms of inflammatory myopathies. The pathogenetic mechanisms and distinguishing histopathological and immunological profiles between polymyositis and dermatomyositis have been highlighted.
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    Intraoperative electrocorticography in epilepsy surgery: useful or not?
    (SEIZURE-EUROPEAN JOURNAL OF EPILEPSY, 2003) Kuruvilla, A; Flink, R
    Intraoperative electrocorticography (ECoG) has been traditionally used in the surgical management of medically refractory partial epilepsies to identify the location and limits of the epileptogenic area, to guide the extent of resection, and to assess its completeness. Although in clinical use for many years, the basic questions regarding indications and limitations of this method has remained unanswered. ECoG plays a major role in tailored temporal lobectomies, whereas, it serves no practical purpose in standard resection of medial temporal lobe epilepsy (TLE) with magnetic resonance imaging (MRI) evidence of mesial temporal sclerosis (MTS). Residual hippocampal spikes, unaltered by resection, correlate with a greater proportion of seizure recurrence. Intraoperative hippocampal ECoG can allow sparing of functionally important hippocampus, thus minimising postoperative memory decline. ECoG eminently aids removal of developmental malformations of brain, and most importantly, the excision of highly epileptogenic cortical dysplasias (CDs) for deciding the extent of resection for best seizure control. The ECoG can be a valuable tool during multiple subpial transections (MST). (C) 2003 BEA Trading Ltd. Published by Elsevier Ltd. All rights reserved.
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    Long term outcome, survival rate and prognosis of idiopathic inflammatory myositis
    (EUROPEAN JOURNAL OF NEUROLOGY, 2009) Ramesha, KN; Kuruvilla, A; Sarma, P
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    Mitochondrial myopathies--a clinicopathological study.
    (Indian journal of pathology & microbiology, 1998)
    Mitochondrial myopathies are heterogeneous group of clinical disorders that can affect multiple systems besides skeletal muscles. The mitochondrial abnormalities in the skeletal muscles are morphologically identified by the presence of characteristic Ragged-red fibers (RRF) in the cryostat sections of the muscle stained with modified Gomori's trichrome stain. In this retrospective study, clinical and histopathological features in six patients with mitochondrial myopathies have been analysed. The utility of histochemical methods in confirming the diagnosis of mitochondrial myopathy has been emphasised.
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    Multipoint incremental motor unit number estimation versus amyotrophic lateral sclerosis functional rating scale and the medical research council sum score as an outcome measure in amyotrophic lateral
    (Annals of Indian Academy of Neurology, 2014-12) Jagtap, SA; Kuruvilla, A; Govind, P; Nair, MD; Sarada, C; Varma, RP
    INTRODUCTION: Monitoring the disease progression in amyotrophic lateral sclerosis (ALS) is a challenge due to different rates of progression between patients. Besides clinical methods to monitor disease progression, such as the ALS functional rating scale (ALSFRS) and the medical research council (MRC) sum score, quantitative methods like motor unit number estimation (MUNE) are of interest. OBJECTIVE: The objective of the present study is to evaluate the rate of progression in ALS using multipoint incremental MUNE and to compare MUNE, ALSFRS and MRC sum score at baseline and at 6 months for progression of the disease. MATERIALS AND METHODS: Multipoint incremental MUNE using median nerve, ALS-FRS and MRC sum score was carried out in 29 ALS patients at baseline and then at 6 months. RESULTS: Of the 29 ALS patients studied, the mean MUNE at baseline was 21.80 (standard deviation [SD]: 19.46, range 4-73), 15.9 in the spinal onset group (SD: 14.60) and 30.16 (SD: 22.89) in the bulbar onset group. Spinal onset patients had 74.02% of baseline MUNE value while bulbar onset patients had only 24.74% baseline value MUNE at 6 months follow-up (Unpaired t-test, P = 0.001). ALSFRS and MRC sum score showed statistically significant decline (P < 0.001) at 6 months follow-up. MUNE had the highest sensitivity for progression of the disease when compared to the ALS FRS and MRC sum score. CONCLUSION: Multipoint incremental MUNE is a valuable tool for outcome measure in ALS and other diseases characterized by motor unit loss. The rate of decline of multipoint incremental MUNE is more sensitive than that of MRC sum score and ALSFRS-R, when expressed as the percentage change from baseline
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    Multipoint incremental motor unit number estimation versus amyotrophic lateral sclerosis functional rating scale and the medical research council sum score as an outcome measure in amyotrophic lateral sclerosis
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2014) Jagtap, SA; Kuruvilla, A; Govind, P; Nair, MD; Sarada, C; Varma, RP
    Introduction: Monitoring the disease progression in amyotrophic lateral sclerosis (ALS) is a challenge due to different rates of progression between patients. Besides clinical methods to monitor disease progression, such as the ALS functional rating scale (ALSFRS) and the medical research council (MRC) sum score, quantitative methods like motor unit number estimation (MUNE) are of interest. Objective: The objective of the present study is to evaluate the rate of progression in ALS using multipoint incremental MUNE and to compare MUNE, ALSFRS and MRC sum score at baseline and at 6 months for progression of the disease. Materials and Methods: Multipoint incremental MUNE using median nerve, ALS-FRS and MRC sum score was carried out in 29 ALS patients at baseline and then at 6 months. Results: Of the 29 ALS patients studied, the mean MUNE at baseline was 21.80 (standard deviation [SD]: 19.46, range 4-73), 15.9 in the spinal onset group (SD: 14.60) and 30.16 (SD: 22.89) in the bulbar onset group. Spinal onset patients had 74.02% of baseline MUNE value while bulbar onset patients had only 24.74% baseline value MUNE at 6 months follow-up (Unpaired t-test, P = 0.001). ALSFRS and MRC sum score showed statistically significant decline (P < 0.001) at 6 months follow-up. MUNE had the highest sensitivity for progression of the disease when compared to the ALS FRS and MRC sum score. Conclusion: Multipoint incremental MUNE is a valuable tool for outcome measure in ALS and other diseases characterized by motor unit loss. The rate of decline of multipoint incremental MUNE is more sensitive than that of MRC sum score and ALSFRS-R, when expressed as the percentage change from baseline.